Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
58 Cards in this Set
- Front
- Back
|
What is maternal death?
|
death of a woman while pregnant or within 42 days of termination of pregnancy
|
|
|
What are the leading causes of death?
|
Hemorrhage (including ectopic pregnancy hemorrhage)
HTN Embolism |
|
|
What is important to know about hemorrhage occurrence, amt, and labs?
|
Early: 24hrs
Late: >24hrs Vaginal: >500mL blood loss C/S: >1000mL of blood loss Hct: dec in 10% |
|
|
What are the risk factors for PP hemorrhage?
|
Overdistention
Prolonged Labor Augmented Labor Precipitious labor Multiparity Tissue Trauma C/S Hx of PPH Chorioamnionitis Manual Placenta removal Retained placenta fragments Previa, accreta, abruption Clotting disorders DIC |
|
|
What are the causes of early PPH?
|
Uterine Atony
Lacerations of genital tract hematoma Retained placental fragments (early or late) Adherent retained placenta inversion DIC |
|
|
What causes uterine atony?
|
Overdistention of the uterus: mutigravida, large baby, hydroamnios
Labor Cx: Prolonged labor Mag sulfate Pitocin |
|
|
What are the causes of late PP hemorrhage?
|
Typically 6 days to 6-7 weeks (no warning)
Subinvolution retained placenta fragments uterine infection |
|
|
Why would retained placenta cause PPH?
|
because clots form around the fragments and cause late PPH
|
|
|
How do you prevent PPH?
|
Prenatal Surveillance
Assessment Placental separation: pitocin Post: Assessment: vs fundus lochia urination q2hrs fundal massage carefully |
|
|
What would you find in an assessment for uterine atony?
|
Can't find fundus (ask)
Boggy uterus is firm with massage then returns to flabby High fundus Large and excessive lochia Large clots Constant steady trickle |
|
|
What is the medical management of uterine atony?
|
Prevention with pitocin (no pump)
Fundal Massage Medications |
|
|
What medications are used for uterine atony?
|
Pitocin
Methergine Prostagladin Carboprost (Hemobate) Prostin E2 Cytotec |
|
|
What is the use dose and s/e of Pitocin?
|
UC and dec bleeding
Dose: 40u IV or 20u IM s/e:water intoxification |
|
|
What is the use dose and s/e of Methergine?
|
UC
Dose: IM q2-4hrs s/e: inc BP do not give if bp: >136/90 |
|
|
What is the use dose and s/e of Prostin E2?
|
UC
Dose: rectal/vaginal suppository S/E: HA NV fever chills |
|
|
What is the use dose and s/e of cytotec
|
UC
Rectal suppository S/E HA NV diarrhea |
|
|
How do you treat uterine atony if meds don't work?
|
Bimanual compression
Uterine packing anesthesia interventions uterine artery embolism D&C Hysterectomy |
|
|
How do you treat PPH?
|
IV fluids: Lactated ringers, saline, blood
Type and cross match O2 mask 10-12L Watch UOP (30-60mL/hr) Frequent VS 3-5mins Teaching (anemia, fatigue) |
|
|
What are the causes of lacerations or hematoma in PPH?
|
Large baby
Precipitous delivery induction vaccume extraction forceps |
|
|
What should be assessed for lacerations in PPH?
|
UC with cont bleeding
Bright red blood my ooze or trickle can be constant REEDA |
|
|
Where are the common sites of hematomas in PPH?
|
Vaginal
Retroperitoneal Vulvar (visible, most common) |
|
|
What is found during the assessment of hematomas in PPH?
|
firm uterus
low BP tachycardia obvious hematoma severe vaginal or peritoneal pain and pressure |
|
|
What is the treatment for hematomas?
|
conservative: allow reabosorption
ice pain relief Large clots: sugical clot evacuation vessle ligation |
|
|
What is the key sign that there is a postpartum infection?
|
Fever >100.4 lasting 2 days during the first 10days PP
not counting the first 24hrs after birth |
|
|
Name the types of PP infections
|
Metritis (endo, myo, and para)
Wound infections UTI Mastitis Septic Pelvic Thrombosis |
|
|
What are the causes of PP infection?
|
Ease of bacterial entry into peritoneum
chlamydia Group B strep Gardnerella Mycoplasma hominis Alkali environment of vag Lacerations (multi small or large) C/S Vag exam |
|
|
What are the risk factors for PP infections?
|
Previous infections
Pre exsisting orgs C/S Trauma Prolonged labor (inc exams) Cath Hemorrhage PROM Dec health Dec nutrition Dec hygiene DM Low SES |
|
|
What are the s/s of metritis?
|
Common with c/s
Uterus pain and tenderness malodorous lochia boggy uterus Fever B-strep may be asymptomatic |
|
|
What are the dx tests used for metritis?
|
Leukocytosis
Positive Cultures |
|
|
What are the interventions for metritis?
|
Fowlers position
COmfort measures: cool compress, warm blankets, perineal care, sitz bath) Meds: IV antibiotics (-sporins, -cillin, -mycin) Antipyretics (lochia and VS) D/C if afebrile x48hrs Teaching meticulous handwashing with perineal care and BF |
|
|
How do you prevent wound infections?
|
hand washing
C/S incision Lacerations episiotomy |
|
|
What are the interventions for wound infections?
|
protect self and baby
comfort measures (sitz baths, warm compress) Hygiene, peri care hydration nutrition rest medication (antibiotics and analgesics) |
|
|
What is the cause of mastitis?
|
staph from mom or baby
stasis or engorgement fatigue stress |
|
|
What are the s/s of mastitis?
|
2-3 weeks PP
Flu-like, chills fever hard tender mass infected nipple fissure usually unilateral |
|
|
What are the mastitis interventions?
|
Antibiotics
Emptying breasts (may BF unless abscess ruptures) Ice (b/w feedings) or warmth (prior) weaning may inc discomfort and risk |
|
|
What are the interventions for UTI?
|
may be symptomatic
fluids (acidic) urinate frequently |
|
|
What are the risks for thromboembolism?
|
Hypercoagulability
Venus stasis Hx Varicosities OC smoking maternal age >35 multiparity |
|
|
What are the types of thromboembolisms?
|
Superficial Thrombosis (lower leg)
DVT (foot to hip) PE (clot in pulmonary artery, comes from amniotic fluid or vein) |
|
|
What is the prevention for thromboembolisms?
|
avoid inactivity or long hours of standing
Avoid prolonged time on bedrest or in stirrups Leg support (hose_ pad stirrups |
|
|
What are the s/s of Thromboembolism?
|
Pain Erythema tenderness
Or may be pale, cool dec peripheral pulses homans sign DVT may require US dx |
|
|
What are the interventions for thromboemoblism?
|
analgesics
rests support hoses put on prior to getting out of bed Activity - no standing or bending at knees for a long time |
|
|
What is superficial venous thrombosis associated with and what re the s/s?
|
Varicose veins (in calf)
IV trauma Swelling Tenderness Warmth |
|
|
What are the s/s of DVTs?
|
Leg swelling >2cm than opposite leg
Erythema heat tenderness over affected area +homans sign pale cool with dec peripheral pulses pain on ambulation and stiffness of leg fever chills general malaise |
|
|
What are the DVT interventions?
|
Heparin or Lovonox (If preg, d/c prior to labor)
Analgesics antibiotics moist heat bedrest elevation of foot gradual ambulation Hep or warfarin = BF on warfarin causes terotogenic defects - use birthcontrol |
|
|
What alternative therapies interact with anticoagulants?
|
Gingko
Feverfew Garlic Chamomile St. Johns Wart (SSyndrome) Goldenseal |
|
|
What are the diagnostics and treatment for PE?
|
CT
V/Q scan Clot lysis with thrombolitic drugs O2 |
|
|
What are the types of psychosocial alterations?
|
PP blues
PP depression PP psychosis |
|
|
What are the s/s of PP blues?
|
day 4/5-10
self limiting: can perform ADLs mild depressive symptoms anxiety, irritability mood swings tearfulness, weepy fatigue, overwhelmed loss of appetite trouble sleeping no tx, goes away in a few days |
|
|
What is PP depression and when does it occur?
|
major depressive episode associated with childbirth
develops over 2-3 months or first yr |
|
|
What are the causes of PP depression?
|
changes in the brain chemistry or structure
plummeting hormone levels dropping progesterone and estrogen dropping thyroid hormone stressful life events |
|
|
What are the predisposing factors for PP depression?
|
personal/family hx
lack of support previous problem with preg financial or relationship problems young age single status substance abuse stress (death, caring for an aging family member, abuse, poverty) |
|
|
What are the s/s of PP depression?
|
all of the blues s/s with:
throughts of hurting the baby thoughts of hurting yourself not having any interest in the baby |
|
|
What nursing interventions should be taken to prevent PPD?
|
rest (sleep when baby is sleeping)
Don't try to be perfect or do too much Ask for support Make time to go out, visit friends, or spend time alone with partner discuss your feelings Talk with other mothers join support group not a bad mom bec of PPD Don't make any major life changes during pregnancy or after leading to unneeded stress If can't be avoided, try to arrange support ahead |
|
|
What nursing assessment should be done for PPD?
|
suicide risk
refer to MD if: suspected depression blues don't go away in 2 weeks s/s of depression get worse Strong feelings of sadness or anger come 1-2months after hard to perform tasks at home or work can't care for baby or self thoughts of harming you or baby |
|
|
When does PPPsychosis occur and what are the s/s?
|
first 3 months PP
dramatic onset: 48-72hrs or first 2 weeks common in bipolar pt or previous episode confusion guilt worthlessness agitation hallucinations/delusions may harm self or baby lack of appetite overly concerned with babys health delusional beliefs r/t infant (baby is dying, satan or god, hallucinations to harm baby) Rapid manic to depressive episodes (disorganized behaviors) Risks for infanticide and suicide |
|
|
What would be found on an assessment of PPP?
|
s/s >6weeks
poor coping low self esteem stressors mood swings previous psychological disorders substance abuse limited support |
|
|
What are the nursing interventions for PPP?
|
encourage verbalization
avoid judgement recommend help with household tasks nutrition, exercise, sleep support structure day to gain control realistic expectations avoid major life changes give info about physiologic changes include family members appropriate referral (hospitalization required) |
|
|
What is the screening for PPD?
|
Over the past 2 weeks have you felt down, depressed, or hopeless?
Over the past 2 weeks have you felt little interest or pleasure in doing things? Depression screening should include systems in place to follow up positive results with subsequent diagnosis and tx |
